BIOLOGICS IN THE TREATMENT OF CALCIUM PYROPHOSPHATE DEPOSITION DISEASE. A SYSTEMATIC LITERATURE REVIEW

Background: Only few case reports and case series have analysed the efficacy of IL-1 inhibitors in the treatment of calcium pyrophosphate deposition disease (CPPD), reporting conflicting results. Objectives: The main aim of this systematic literature review (SLR) was to summarize the evidence in the use of biological therapies in CPPD. Methods: PRISMA-IPD guidelines were used for this review. Published articles reporting the use of TNFα and/or IL-1 inhibitors in the treatment of CPPD were reviewed. We performed a SLR using PubMed, Embase and Cochrane databases. The search resulted in 83 articles; 11 were further evaluated in the SLR. Results: Seventy-six patients were included: 2 received infliximab, whereas 74 anakinra. The main data of included studies are reported in table 1 . Table 1. Studies evaluating biological therapies in patients with CPPD. Authors Year of publication Population of interest Number of CPPD patients Diagnostic criteria Clinical presentation McGonagle D. et al. 2008 CPPD 1 SFA Chronic Announ N. et al. 2009 CPPD 1 SFA Acute Couderc M. et al. 2012 CPPD 3 Imaging Acute and chronic Diamantopoulos A.P. et al. 2012 CPPD 1 SFA Chronic Moltó A. et al. 2012 CPPD 5 SFA Acute and chronic Ottaviani S. et al. 2013 CPPD 16 SFA and/or imaging Acute Verhoeven F. et al. 2013 G and CPPD 2 NR Acute and chronic Bruges-Armas J. et al. 2014 CPPD 2 NR Chronic Aouba A. et al. 2015 G, CPPD and HADD 1 Imaging Acute Desmarais J. et al. 2018 G, CPPD 11 SFA and/or imaging Acute Thomas M. et al. 2018 CPPD 32 SFA and/or imaging Acute Legend . G : gout, HADD : hydroxyapatite deposition disease, NR : not reported, SFA : synovial fluid analysis Table 2. Efficacy of anakinra in the treatment of CPPD Acute CPPD (n=67 ) Chronic CPPD (n=7 ) Clinical efficacy (%) 54 (80.6) 3 (42.9) Pre TJC 6.3±2.4 3.8±2.4 Post TJC 1.2±0.6 1.3±1.5 Mean reduction 5.1±2.3 * 2.5±1.9 + Pre SJC 4.8±2.2 3.8±2.4 Post SJC 1.1±0.6 1.3±1.5 Mean reduction 3.7±2.2 * 2.5±1.9 + Pre VAS pain (0-100 mm) 68.5±9.5 / Post VAS pain (0-100 mm) 24.2±10.4 / Mean reduction 44.2±10.9 * / Pre CRP (mg/l) 40.9±50.9 50.0±66.5 Post CRP (mg/l) 22.2±8.6 3.2±2.5 Mean reduction 18.6±54.1 * 46.7±64.0 + Legend. CRP : C-reactive protein, SJC : swollen joint count, TJC : tender joint count, VAS : visual analogue scale. + p values were not calculated because of a too small sample size. * p values were <0.01 Sixty-seven (88.2%) patients presented with an acute CPPD (mean disease duration: 2.7±6.9 months; polyarticular involvement in 61.2%, oligoarticular in 31.3% and monoarticular in 7.5%), whereas 9 (11.8%) patients with a chronic CPPD (mean disease duration: 130.1±133.6 months; polyarticular involvement in 66.7% and oligoarticular in 33.3%). Anakinra was used in refractory disease (85.1%) or in patients with contraindications to standard treatments such as colchicine, oral glucocorticoids and/or non-steroidal anti-inflammatory drugs (23.0%). Clinical response to anakinra was reported in table 2 . Duration of anakinra treatment prior to complete resolution of symptoms was associated with the clinical phenotype of chronic CPPD (Rpb: 0.67, p<0.01) and with disease duration (R: 0.49, p<0.01). In 47 out of 57 (82.5%) responders, complete resolution of symptoms was observed within 4 days after the first injection of anakinra. Adverse events were reported in 4.1% of the cases: local skin reaction at the injection site, skin rash on the back and bacterial pneumonia. Conclusion: This SLR provides evidence in favour of the use of anakinra as a therapeutic option in patients with CPPD, especially in acute refractory CPPD or when standard treatments are contraindicated. Disclosure of Interests : Edoardo Cipolletta: None declared, Andrea Di Matteo Grant/research support from: the publication was conducted while Dr. Di Matteo was an ARTICULUM fellow, Anna Scanu: None declared, Martina Isidori: None declared, Jacopo Di Battista: None declared, Leonardo Punzi: None declared, Walter Grassi Speakers bureau: Prof. Grassi reports personal fees from AbbVie, personal fees from Celgene, personal fees from Grünenthal, personal fees from Pfizer, personal fees from Union Chimique Belge Pharma, outside the submitted work., Emilio Filippucci Speakers bureau: Dr. Filippucci reports personal fees from AbbVie, personal fees from Bristol-Myers Squibb, personal fees from Celgene, personal fees from Roche, personal fees from Union Chimique Belge Pharma, personal fees from Pfizer, outside the submitted work. Citation: Ann Rheum Dis, volume 79, supplement 1, year 2020, page 443Session: Crystal diseases, metabolic bone diseases other than osteoporosis (Poster Presentations)